Vincent Obias Editor Robotic Colon and Rectal Surgery Principles and Practice 123 Robotic Colon and Rectal Surgery Vincent Obias Editor Robotic Colon and Rectal Surgery Principles and Practice Editor Vincent Obias Department of Surgery Division of Colon and Rectal Surgery George Washington University Washington, DC, USA ISBN 978-3-319-43254-0 ISBN 978-3-319-43256-4 (eBook) DOI 10.1007/978-3-319-43256-4 Library of Congress Control Number: 2016962016 © Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland This book is dedicated to all of the surgeons who are courageous enough to thoughtfully utilize a new technology or technique to improve the outcomes of their patients, to question these advancements, to critically review and publish their results, and, once these surgeons are comfortable with their mastery, to continue to innovate and try new ideas. Foreword Issac Asimov’s Three Laws of Robotics 1. A robot may not injure a human being or, through inaction, allow a human being to come to harm. 2. A robot must obey the orders given it by human beings except where such orders would conflict with the First Law. 3. A robot must protect its own existence as long as such protection does not con- flict with the First or Second Laws.1 Robotics, in its current form, is not the robot from fiction and movies. Rather, it is a mechanized computer interface that augments a surgeon’s innate abilities. Robotic surgery is a natural continuation of minimally invasive surgery that was pioneered by laparoscopists and endoscopists. As has been the case in many instances in science and industry, the advent of robotics has disrupted the status quo and has helped move the field of surgery forward. At its base, robotics is a mechanized computer interface between the surgeon and the patient. However, instead of separating the patient from the surgeon, robotic draws the surgeon closer with incredible 3D views and fine wristed instruments. As technology continues its exponential pace, future iterations of robotic platforms will look radically different from what we have used as pio- neers, but the basic surgeon-computer-patient paradigm will always be there. It is with great pleasure that I introduce the reader to the first edition of this text- book. The genesis of this textbook was rooted in the realization that current robotic colorectal textbooks were being written and edited by surgeons who did not do robotics. All of the main authors in this textbook have done over 100 robotic colorectal procedures and are experts in the field. They truly support and endorse robotics in colorectal surgery and their enthusiasm shines through in the chapters they have written. Thank you for reading this textbook. I hope you enjoy this labor of love. Vincent J. Obias, MD, MS, FASCRS, FACS 1 Asimov, Issac, I, Robot. 1950. vii Contents 1 Introduction: The Evolution of Minimally Invasive Surgery ............. 1 Jeremy L. Holzmacher and Samir Agarwal 2 The Learning Curve of Robotic Assisted Laparoscopic Colorectal Surgery and How to Start Applying Robotic Technology in Colorectal Surgery ......................................................... 11 M. Nicole Lamb and Ovunc Bardakcioglu 3 Training and Credentialing in Robotics ................................................ 17 Ryan Broderick, Simone Langness, and Sonia Ramamoorthy 4 Robotic Right Hemicolectomy ............................................................... 23 Henry J. Lujan, Brian X. Rivera, and Diego Holguin 5 Robotic Abdominoperineal Resection ................................................... 49 Grace S. Hwang, John Gahagan, and Alessio Pigazzi 6 Robotic Low Anterior Resection of Rectal Cancer .............................. 59 Se-Jin Baek and Seon-Hahn Kim 7 Robotic Total Colectomy ........................................................................ 79 Cesar Santiago and Sean Satey 8 Robotic-Assisted Transanal Microscopic Surgery ............................... 93 Borja Villanueva Figueredo, Federico Perez Quirante, Carlos Martinez Parra, Jorge A. Lagares-Garcia, and Anthony Firilas 9 Surgical Immunofluorescence and Firefly Technology in Colon and Rectal Surgery .................................................................. 105 Elizabeth R. Raskin 10 Surgery on Obese Patients ..................................................................... 115 Eduardo Parra Davila and Carlos Hartmann Otero 11 Robotics and Pelvic Floor ....................................................................... 129 Nell Maloney-Patel, Juana Hutchinson-Colas, and Ashley Tsang ix x Contents 12 Robotic Surgery for the Treatment of Inflammatory Bowel Disease .......................................................................................... 153 Michelle DeLeon and Craig Rezac 13 Ergonomics in Robotic Colorectal Surgery .......................................... 169 John G. Armstrong and John C. Byrn 14 Nerve Preservation in Robotic Rectal Surgery .................................... 183 Fabrizio Luca and Manuela Valvo 15 Completed and Ongoing Trials in Robotic Colorectal Surgery .......... 195 Robert K. Cleary 16 Robotic Costs ........................................................................................... 229 Deborah S. Keller and Eric M. Haas 17 The Robotic-Assisted Treatment of Endometriosis: A Colorectal Surgical Perspective ......................................................... 243 Maria Victoria Vargas, Gaby Moawad, Vincent Obias, and Madiha Aziz 18 Anesthesia in Robotic Colon and Rectal Surgery ................................ 259 Christopher Schroff and Jason Sankar 19 Single-Incision Robotic Colon Resection (SIRC) ................................. 271 Yen-Yi Juo and Vincent Obias 20 Intraoperative Conversions in Robotic Colorectal Surgery ............... 285 Matthew Skancke and Vincent Obias 21 Current and Future Platforms for Robotic Colorectal Surgery ......... 295 Jeffrey N. Harr and Deborah Nagle Acknowledgements ......................................................................................... 311 Index ................................................................................................................. 313 Chapter 1 Introduction: The Evolution of Minimally Invasive Surgery Jeremy L. Holzmacher and Samir Agarwal Perhaps the most invigorating and daunting challenge to the modern day surgeon is the continual drive to push the envelope of what is innovative, fast, and cost effec- tive. Likewise, surgeons must at all times maintain patient safety and provide treat- ments that are as efficacious as the current standard of care. As surgery began forming into a cogent specialty in the late nineteenth and early twentieth century, foundational strides were made in advancing antisepsis and sterility along with updating the current body of anatomic knowledge. Around this same time, the developing interest in the basic sciences lead to the birth of the surgeon scientist who formally set to define the pathological basis for surgical disease. William Stewart Halsted was one of the key figures in removing the general surgeon from the paradigm of the surgeon barber of the 1800s into the surgeon scientist of the twen- tieth century. This was part and parcel to his pursuit of the scientific of surgical diseases, and in many respects set the tone of translational research from the labora- tory to the operating room. Of course, his achievements were built upon meticulous and often tireless efforts of the great surgeons that came before him. Physicians who explored nearly every cavity, crevice, and orifice of the human body and for whom so many eponyms exist. As the century progressed, a wave of new technologies began surfacing which would come to empower both diagnostic and therapeutic medicine. Henry Dakin and Nobel laureate Alexis Carrel did extensive research into wound management during World War I, leading to major advancements in wound healing by experi- menting with antisepsis solutions and the evolving practice of debridement and irrigation. By World War II, most of the foundations for basic operative procedures had been established and the subsequent growth of surgical procedures from the J.L. Holzmacher, M.D. • S. Agarwal, M.D. (*) School of Medicine and Health Sciences, Department of Surgery, George Washington University, 2150 Pennsylvania Ave. NW, Suite 6B, Washington 20037, DISTRICT OF COLUMBIA, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 1 V. Obias (ed.), Robotic Colon and Rectal Surgery, DOI 10.1007/978-3-319-43256-4_1 2 J.L. Holzmacher and S. Agarwal 1940s onward became nearly exponential. Diseases, which were lethal only decades earlier, could now be treated in a precise and nuanced fashion. The mod- ern era of major open surgery had come, it was radical in breadth and scope, and the evolution of surgery as a field had only begun. The Dawn of Endoscopy While open surgery dominated as the sole intervention for surgical disease for the majority of the twentieth century, concurrent advances in catheter-based and endo- scopic technology set the foundation for what would become minimally invasive surgery. In their infancy, however, minimally invasive approaches were largely regarded as ineffective for interventional means. Indeed, the adoption of minimally invasive procedures like endoscopy by thoracic and abdominal surgeons was delayed largely by two key factors: (1) endoscopy was deemed inferior to the gold standard of open surgery, especially when dealing with enclosed intracorporeal cavities; and (2) the technology of endoscopes was limited by their lack of video- imaging capabilities, high definition visualizations, and insufficient lighting for the operating surgeon and their assistants to perform meaningful maneuvers. Consequently, surgeons sparingly performed endoscopy leaving a vacuum through which other specialties would advance the field. The toils and triumphs of these pioneers are as expansive as the achievements of the great major operative sur- geons of the time. Kurt Semm, a gynecologist, succeeded in developing an electronic insufflator with trocar systems that allowed introduction and removal of instruments without losing intra-abdominal pressure, and his performance of the first laparoscopic appendectomies (Figs. 1.1 and 1.2). The radiologist Benjamin Orndoff began exper- imenting with “peritoneoscopy” and was able to establish pneumoperitoneum using an intraspinal needle by insufflating oxygen. Similarly, Janos Veress developed a modified intraspinal needle to instill pneumothorax for the treatment of tuberculo- sis, later to be adopted for introduction of pneumoperitoneum (Fig. 1.3). George Kelling, a gastroenterologist, experimented feverishly with methods of insufflation and insufflating gases, as well as conceptualizing and describing the beginnings of what would ultimately become modern day laparoscopic instruments (Fig. 1.4). A true endoscopist, George Berci of Austria led advances in miniaturizing video- imaging technology within endoscopes and improving endoscopic illumination, setting the stage for high definition televised laparoscopes for visualizing intracavi- tary anatomy (Figs. 1.5 and 1.6). Surgery via laparoscopy, however, was not first successfully performed until the early 1980s by European surgeons using their own personal techniques for chole- cystectomy. The legitimacy of endoscopy became solidified in 1987 when the French physician P. Mouret who performed a four trocar laparoscopic cholecystec- tomy successfully in a young woman.